Football will keep killing players until we change the way it’s played

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Obsession

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Written by

Obsession

In an old, converted garage, Vicis employees enthusiastically beat the crap out of football helmets. They call it the “Smash Lab.”

The goal, of course, isn’t to destroy sports equipment. It’s to see if they can protect the heads they encase—human heads, outside the lab; dummies like those used in crash tests, when inside. I asked the engineer working the Smash Lab if they named the dummy heads, and he shrugged. “Whoever you’re mad at that day.”

At this point, we know football is unsafe. Study after study has come out in recent years solidifying the undeniable link between years of playing football—and the hits to the head that entails—to chronic traumatic encephalopathy. Helmets have long been the ostensible bulwark against debilitating head injuries for football players. But, clearly, the ones we have aren’t working. The question that Vicis and others are now trying to answer is: could a different helmet, better engineered, based on better science, save football from its head-injury problem?

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Chronic traumatic encephalopathy, or CTE, is a neurodegenerative form of dementia, which means it gets worse with age. As of now, it can only be definitively diagnosed through autopsies. In living players, the illness usually shows up first as symptoms like frequent headaches and difficulty focusing, eventually progressing to aggression, impulse control, depression, dementia, and suicidal ideation. In November 2017, Aaron Hernandez, a former New England Patriots tight end who was jailed for the first-degree murder of a friend, committed suicide at 27. An autopsy revealed that Hernandez’s brain had all the hallmarks of advanced CTE; it was the first time experts had seen a brain like this in someone younger than 46.

Growing acceptance of the alarming connection between football and CTE has begun to impact the professional leagues. A handful of National Football League (NFL) players have started retiring early to protect their health. In 2015, San Francisco 49ers linebacker Chris Borland, an emerging young star, told ESPN he was leaving the sport after just one year as a pro because he worried about developing neurological diseases later in life.

The NFL has begrudgingly acknowledged the risks associated with the sport after years (paywall) of denial and allegedly worse: the league has been accused of actively suppressing concussion reports, though it denies these accusations. The NFL has started to take action to investigate football safety, including launching the Engineering Roadmap, a campaign started in 2016 to get helmet companies to innovate in ways that would improve player safety. The Roadmap provided manufacturers at any level clear instructions on what areas of helmets needed improving, how to install accelerometers to measure impacts, and a chance to win some $60 million research grant to fund their project over the course of five years. (For context, the NFL brought in $14 billion in revenue in 2017.)

One of the most lauded products to come out of this effort was the Vicis Zero1 helmet, which debuted on the field at the professional and collegiate levels at the start of the 2017-2018 season.

Before Vicis, there wasn’t much variety in football helmet technology. There were four other companies making helmets for the NFL—Schutt, Riddell, Xenith, and Rawlings—and every one of their products was basically a hard plastic shell with foam padding inside, and a grated plastic face mask. This is because most helmet manufacturers are satisfied with their products as long as they’re compliant with league standards, set in 1973 by the National Operating Committee on Standards for Athletic Equipment (NOCSAE).

The NFL uses the same helmet standards today as it did in 1976. (AP Photo)

NOCSAE was and still is a non-profit without any regulatory function or power, but they set a bar that, over 40 years later, is still deemed reasonable by the NFL, the National Collegiate Athletic Association, and the National Federation of State High School Associations.

NOCSAE-approved helmets must pass a drop test (pdf) where they hit a solid surface at speeds ranging from roughly 11 to 18 feet per second from all sides—basically, settings designed to mirror what would happen to a player during a game. They also have to be tested at temperatures above 100°F (38°C), to make sure the helmets don’t buckle in hot August games.

The committee uses a mysterious unit called severity index (pdf), that purportedly measures the probability a helmet will prevent a serious head injury at a particular impact; the better a helmet performs, the lower its SI. To get approval, a helmet can’t go over 300 SI on slow drops or 1,200 SI on faster ones. (NOCSAE doesn’t share helmets’ exact scores with their manufacturers.)

Vicis was formed in 2013 by three men—Dave Marver, who has a background in management at a medical device company, Sam Browd, a pediatric neurosurgeon and current medical director at the Seattle Children’s Sports Concussion Program, and Per Reinhall, a mechanical engineer at University of Washington and the chair of the advanced research center at Boeing—who wanted to do more than just meet NOCSAE’s standards.It sounded like the helmet should have cracked, but it bounced back, unscathed.

Unlike traditional helmets, which are basically shells filled with foam, the Zero1 has a “soft” design: its shell contains plastic columns that, when hit with enough force, either compress or shift position in order to deflect some of the impact. (The company had to develop a special type of paint that won’t crack on impact.) The helmets also fit much tighter around the player’s head. In theory, these two factors combine to force a player’s head to remain more stable when hit than would a standard helmet design—and decrease the impact of the hit.

In the Smash Lab, Vicis has a drop-test setup meant to assess their helmets against NOCSAE standards. They also have a pneumatic ram, which uses compressed air to send a rod slamming into a helmet at speeds up to about 30 ft per second. Inside each helmet is a dummy head equipped with wobbly necks like our own, and accelerometers to measure the impact.

In early January, a mechanical engineer showed me how they modeled the impact of a quarterback getting tackled and hitting the ground: the pneumatic ram hit the back of a Zero1 Helmet at 20 ft per second, making a loud thwok sound. It sounded like the helmet should have cracked, but it bounced back, unscathed. More importantly, Vicis claims, the accelerometer shows the dummy head inside it was okay, too.

After the Zero1 came out, sports media wrote about it as though it would save the sport.

This past football season, over 60 players on 18 different NFL and top-20-ranked college teams chose to switch over to the Zero1. This was the first season the helmet was used in games, and the feedback was generally positive. “You don’t feel the thuds as hard as they normally are,” Cliff Avril, a Seattle Seahawks defensive end, told CNN in September, one week into the season. Notre Dame University has declared that all its football players will use the Zero1 in the upcoming 2018 season. When I visited Vicis, the company’s chief executive Dave Marver told me players and equipment managers universally say the Zero1s feel better, reduce injuries, and show less wear and tear than traditional helmets.“You don’t feel the thuds as hard as they normally are.”

The Zero1 currently costs $950, not too expensive for professional and bigger college teams, but definitely out of range for most teams at smaller universities and high schools. (In theory, a helmet should last a player a season.) Marver says as demand for the Zero1 increases, the price will drop. It’s already $550 less than the $1,500 it cost at the start of the 2017 season, and Marver says the goal is to reach a production scale at which they can sell at a price that anyone playing tackle football, at any level, can afford.

All of this is well and good—except there are very little concrete data about whether these helmets are actually safer.

The NFL conducts its own annual impact testing for the helmets used in the pros with an independent lab in Canada, and the Zero1 came out on top this year—but the quantitative data from that study is unavailable to the public.In the pros, players sometimes hit each other at accelerations as high as 150 Gs.

Vicis also provided Quartz with data from testing it had conducted at the helmet testing labs at Virginia Tech. In these tests against three other helmets popular in the NFL, the Zero1 was the best at reducing impact to the head. For example, when dropped on their side (where the most intense, concussion-level hits occur) the Zero1s were hit with an average force of 69 Gs, or 69 times the force of gravity on Earth. The other helmets averaged between 75 and 90 Gs. Concussions tend to occur at hits around 100 G (although they can occur at lower impacts, too). In the pros, players sometimes hit each other at accelerations as high as 150 Gs.

Stefan Duma, a mechanical engineer who directs the helmet lab at Virginia Tech, confirmed that Vicis had used the lab in the past, but that university researchers didn’t validate the resulting data. In addition, none of these data have been peer-reviewed, nor have they been made public. Vicis says that this is because Virginia Tech’s labs currently doesn’t use the same testing protocols as the NFL. (Duma says his lab plans to test the Zero1 as soon as it can purchase one independently.)

Perhaps more worryingly is the disclaimer at the bottom of promotional Vicis videos: “A correlation between impact reduction and reduced concussion risk has not been established.”

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Head injury isn’t just a football problem. As far back in the 1920s, doctors were publishing peer-reviewed studies describing former boxers who began to act “goofy” and “punch drunk” (paywall) as they grew older. The boxers would develop trouble walking and mild confusion before their symptoms progressed to full gait-changes and obvious cognition problems. Sometimes, they’d become more aggressive and quick to anger. Medical researchers in the early 20th century called the condition “dementia pugilistica”; we now know it as CTE, and know that even one concussion can have serious long-term health repercussions.

As scientific understanding of head injuries has improved, most public campaigns in football have focused on preventing and treating concussions. In 2010, the US Centers for Disease Control worked with the NFL and the NFL Player’s Association to put up posters (pdf) in locker rooms explaining how to recognize the symptoms of a concussion, and advocating that if felt any of the symptoms, they should alert their coaches so they could be taken out of the game.On the prevention side, most efforts to date have focused on designing better helmets.

On the prevention side, most efforts to date have focused on designing better helmets. In 2016, the NFL launched the Play Smart, Play Safe initiative (which includes the Engineering Roadmap). In addition to the $60 million the NFL promised to award to innovative helmet-manufacturers, the league also pledged $40 million to independent neuroscience research—which theoretically leads to insights on how to make the game safer. The NFL’s Engineering Committee, chaired by the director of the University of Virginia’s biomechanics program, started analyzing videos of all the concussions sustained during the 2015-16 season (a brief analysis of which can be found here) and plans to do the same for the following seasons.

That might be misguided; it’s not necessarily getting hit on the head that’s the problem.

“As soon as the head hits, it twists around the neck,” says Jamshid Ghajar, director of the Stanford Concussion and Brain Performance Center. It’s the twisting that rattles the brain and causes injuries. That’s not to say improving head protection is pointless. “If you wanted to have the best helmet, the way Vicis has designed is terrific,” says Ghajar. But, he adds, “you need something like that, plus [some device for] the neck.”

Ideally, he says, football players would be equipped with a neck guard allowing them to move their heads slowly—enabling normal movement like a defensive back looking around for an open receiver—but that locks into place at higher speeds when they get hit hard. It would act sort of like how a seatbelt locks into place during a car crash. This is certainly feasible from an engineering perspective, but football players may not take to such a novel piece of equipment, so it’s a risky investment. No company has made meaningful progress developing a football neck brace.

Perhaps the bigger issue is that even if football eliminated concussions from the game, CTE would still be a risk for football players just by the nature of getting hit. As research on traumatic brain injury has progressed, it’s starting to look like CTE is actually caused by multiple blows to the head, regardless of whether they were hard enough to cause a full-blown concussion. A helmet—or neck brace—by its very existence is an admission that players are still taking potentially dangerous hits to the head.

“The more the focus is on concussion, the less likely there will be any meaningful change to the research or the safety of the sport,” says Robert Stern, a neurologist at Boston University.Tackling the way most players do at any level can cause lasting brain damage.

Almost every single football player who has donated his body to science has shown signs of the illness in post-mortem autopsies—regardless of how often they were concussed during their playing careers, and whether they made it to the pros or even played at the college level. In 2016, a group of researchers published some of the first work (paywall) showing a relationship between repeated hits to the head and problems with memory and behavior. These two symptoms are hallmarks of CTE. In other words, tackling the way most players do at any level can cause lasting brain damage.

CTE eats away at the brain. (Boston University Center for the Study of Traumatic Encephalopathy)

CTE is a result of healing gone wrong, Stern explains. Hits to the head cause damage at the cellular level that can usually be fixed by the immune system, allowing the brain to recover. But getting hit again and again makes damaged cells pile up, which overwhelms the cellular clean-up crew. The brain becomes inflamed, and starts making sloppy copies of tau, a protein that, when healthy, forms sturdy connections between the parts of neurons that stretch out to reach others. “That altered tau eventually stops doing what [they’re] supposed to do in a healthy brain cell, and starts destroying [it],” Stern says.

By the time someone starts showing CTE symptoms, it’s too late.

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Tackling is the hallmark of football. It’s also what makes football dangerous.

In part, this is because the definition of a “tackle” in the official rulebook is vague: it’s an “attempt by a defensive player to hold a runner to halt his advance or bring him to the ground.” It doesn’t matter how you do it, as long as it gets done.“Of course, I’m going to listen to [my coaches]. But at the same time, I would feel my bell getting rung”

“Growing up, how I was taught to tackle was [with] the head across,” says Scott Lawyer, a former linebacker at the University of Washington. “I thought it was the right thing because everyone else was doing it.” In a “head-across” tackle, the defensive player runs at the offensive player sideways, then throws his head and neck across the offensive player’s chest. He blocks the offensive player’s body, but in a way that leaves them both unbalanced, with the defensive player’s head in a vulnerable position. Thus, the tackler ends up taking the brunt of the force of the hit.

“Of course, I’m going to listen to [my coaches],” he says. “But at the same time, I would feel my bell getting rung.” Lawyer now works for Atavus, a Seattle-based coaching and analytics company for rugby and football, with an emphasis on tackle techniques. Its football program has worked with Ohio State, University of Washington, Rutgers, Nebraska, and Michigan State at the collegiate level, and with the Seattle Seahawks in the NFL.

But they don’t teach tackling the same way Lawyer learned. Atavus, which was formed in 2013, teaches players to take their head out of the equation.

Atavus-style tackling still emphasizes leading with the shoulder as the point of contact, but also making sure the leg on the same side of the leading shoulder is pushing forward—similar to a rugby tackle. This way, tacklers keep their heads out of a direct line of contact with the offensive player’s body.

Even better, if you’re into big hits: In Atavus-style tackling, the defensive player has to set himself up to plow forward into the offensive player, and takes what’s called a power step with his opposite foot just before he hits. When he finally makes contact with the offensive player, his stance a lot more stable, making the tackle more forceful. “Our emphasis is to keep the head out of that equation so you can maximize power,” says Rex Norris, the head football coach at Atavus.

As with Vicis’ Zero1 helmet, those who have used the Atavus tackling method sing its praises. For example, Pete Carroll, the head coach of the Seahawks, has said his players started to tackle better because of the company’s interventions. But also like Vicis, Atavus lacks concrete data to validate the word of mouth. Although the company collects meticulous records of every single tackle made by its client teams (for a fee), there aren’t enough yet to prove the Atavus method is actually safer.

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I was about to leave the Atavus when Norris and asked if I wanted to learn how to tackle.

I’d never tackled anyone in my life, and Atavus tackling isn’t intuitive even for those who’ve made a career out of knocking others down. Players have to learn to make hits with their hips over their knees, almost leaning into the player they’re trying to bring to the ground. They also have to learn to throw their arms up and forward, which, when done right, engages the muscles around the shoulder to protect the joint. But in theory, if players can master all of that, they can hit with full force without hurting themselves.

I figured I was there, so why not? I tried it in slow motion a couple of times, and then ran full-force into Lawyer. To my surprise—he has more than 100 pounds on me, and it looked to be mostly muscle—I was able to force him to stumble backward. My shoulder hurt where I made contact, but it wasn’t unbearable.

Gaining confidence, I tried again. Except this time, I messed up my footwork, and felt the full force of hitting Lawyer in my elbow. It was a stunning kind of pain, and when I staggered away Norris said, “See, you were late there. Your knee was out in front of your hip.”

It hurt every time I rotated my wrist for a few days afterwards. Every time I winced, I thought about these men who’d dedicated so many years of their lives to a sport where getting hit is essentially a required part of play.Overcoming physical struggle taps into a primal human desire, while structured competition celebrates more advanced cultural traits

I believe sports can be great. Overcoming physical struggle taps into a primal human desire, while structured competition celebrates more advanced cultural traits like determination, humility, teamwork, and grace. I grew up playing competitive tennis, and in college I started running marathons. I finished a 50k-run through pouring rain last year. I know what it’s like to bring yourself to vomit, tears, and injury for the sake of athletics. But each time, I’ve been the one bringing the pain onto myself.

Football players have to endure the pain that comes with pushing themselves, along with that exacted by opponents who physically force them to the ground dozens of times every game. To say football is too dangerous to play would mean negating the thousands of hours spent practicing and playing, but also the willpower needed to keep stepping onto a field when you know you’re going to get plowed down as you try to reach your goal. It’s a side of the human spirit we rarely, if ever, see elsewhere.

To be very clear: the science showing the detrimental impact of football-related head injuries damage is damning. But in the past science has also given us innovations, like seatbelts, to make extremely dangerous activities far safer. So I wanted to ask one more time: can it make football safe?

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Most people don’t like change, Norris says. Atavus tackling takes time to learn, and players who have developed a tackling style over decades of practice aren’t going to give it up readily.

Science tends to make life safer. But it typically requires forced adoption. Seatbelts, for example, work really well at saving lives in car crashes, but they work best when passengers use them. At first no one wanted to wear them, but 50 years ago, laws mandated them. Now everyone recognizes that they save lives. Even if the data end up proving Atavus’ tackling and Vicis’ helmets make football safer, they surely won’t succeed without some kind of enforcement from above, or widespread initiative from within the game.

The NFL makes minor tweaks to the rules of play annually (it’s made 47 since 2002) and occasionally there are major changes, sometimes for the sake of player safety. I asked Allen Sills, a neuroscientist and chief medical officer at the NFL, if the league would ever consider forcing players to wear Zero1 helmets, or banning any non-shoulder-style tackle.

There isn’t even enough good science to make the basic case that these interventions can reduce head injuries.“We want to continue to minimize hits to the head,” Sills says. “There are constant, ongoing conversations between those of us who are involved in caring for athletes and gathering injury data and those who are making the rules.” The NFL is researching position-specific helmets as part of the Engineering Roadmap, Sills says. The idea is all players will have some head protection, but positions that are tackled most often, like running back, would have to wear extra-protective helmets. And in 2016 the league profiled the Seattle Seahawks’ efforts to play with Atavus’ signature shoulder tackle in a 30-second commercial, referring to it as “the future of football.”

However, Sills says there isn’t enough data to support a change to the game at the scale I suggested. And he’s right. There isn’t even enough good science to make the basic case that these interventions can reduce head injuries.

After I left Seattle, I kept floating the idea of eliminating tackling from football in conversation with friends. Some said maybe the game could become flag- or touch-football; others suggested eliminating the positions (paywall) that get hit the most.

But, realistically, without hard tackles the game wouldn’t be nearly as fun to watch. The big hits of football are ingrained deeply into the culture of the sport. Knowing these young athletes could be doomed to progressive form of dementia has ruined football for me. But taking the big hits out of the game would probably end it entirely.

Correction: An earlier version of this piece omitted that CEO Dave Marver also co-founded Vicis. It also misstated the original price of the Zero1 helmet. It was $1,500, not $1,550.